TASK ASSIGNMENT NOTIFICATION FORM

DEP CONTRACT NO.

Task Assignment Number: Date:

Project Name:

Owner’s Name: County(s):

Parcel ID:

Managing Agency:

Acreage:

Value:

BLA#:

Contractor: FEID No:

Contractor Contract Manager: Phone Number:

DEP Designated Task Manager: Phone Number:

Subcontractors: (List, if any) ___________________________ MBE:

___________________________________________________ MBE:

DEP Contract Manager: Phone Number:

Task Description (Use additional sheets if necessary): This Task is to provide a Title Commitment on the parcels described above and attached as Exhibit “A” in accordance with the specifications attached as Exhibit “F”.

Deliverable: Contractor shall provide Title Commitment.

Performance Measure: DEP Contract Manager will review deliverable to ensure specifications were met.

Financial Consequences: DEP will not pay for unsatisfactory deliverables. Contractor shall be given the right to remedy at no cost to DEP.

, in approved contracted rates for the Contract Title Closing Services: Title Search/Closing Commitment accordance with the rate schedule attached as Exhibit “B”.

Liquidated Damages Per Day Charges:

Task Assignment Type: Amount Not To Exceed:

FLORIDA DEPARTMENT OF ENVIRONMENTAL

PROTECTION

DEP Contract Manager or designee Date

Fee Schedule

Commitment Only

Total Task Assignment Value

Contract Manager Date Authorized to execute Task Assignments

APPROVED:

Contractual Authority Date

Funding Authority Date

If Closing Occurs: The Contractor will be paid the Title Insurance Policy for Closing (Insurance Premium / Promulgated Rate), and Closing Fee ( on the HUD/Closing Statement.

Title Commitment Due Date: days or best time frame if less, after execution of Task Assignment Task Assignment End Date: days after Closing

FOR DEPARTMENT USE ONLY: Funding Information:

Org. Code E.O. Fund Object

Code Budget Entity

Cat Module Project # Year Amount cc: Procurement Section (MS93) -1 PDF

BLA Number Request and Task Initiation Form

Donations/ Title / ESA Please attach all documentation as backup

From:

Date Requested:

Project Name:

Owners Name:

Parcel Id # /Sheets:

Legal Descriptions:

County:

Acreage:

Value:

Contractor:

Type of Interest Per Title Company:

Managing Agency/ Contact Person:

Funding Source/ Information:

BLA: _______________________

Assigned By: _______________________

Date Assigned: _______________________

Parcel ID Acreage JTAV 1 31 46 36 A00 0003.0000 23.34 103710 1 31 47 01 A00 0003.0000 1.61 7245 1 31 47 04 A00 0001.0000 150.8 655945 1 32 46 31 A00 0001.0000 574.48 2749535 1 32 46 32 A00 0001.0000 577.72 2529848 1 32 46 33 A00 0001.0000 575 2496933 1 32 46 34 A00 0003.0000 51.06 225205 1 32 47 04 A00 0001.0000 42.8 190688 1 32 47 05 A00 0003.0000 52.43 233505 1 32 47 06 A00 0001.0000 47.43 210863 1 31 46 33 A00 0002.0000 585 2555500 Totals 2681.67 11958977